Therapeutics and Clinical Risk Management (Aug 2021)
Effect of the Timing of Surgery on Neurological Recovery for Patients with Incomplete Paraplegia Caused by Metastatic Spinal Cord Compression
Abstract
Yunpeng Cui,1 Xuedong Shi,1 Chunwei Li,2 Chuan Mi,1 Bing Wang,1 Yuanxing Pan,1 Yunfei Lin1 1Department of Orthopaedics, Peking University First Hospital, Beijing, People’s Republic of China; 2Department of Neurosurgery, Peking University First Hospital, Beijing, People’s Republic of ChinaCorrespondence: Xuedong ShiDepartment of Orthopedic, Peking University First Hospital, No. 7 Xishiku Street, Xicheng District, Beijing, 100032, People’s Republic of ChinaTel +86 10-83575660Email [email protected]: This study aimed to investigate the effect of timing of surgery on neurological recovery for patients with metastatic spinal cord compression (MSCC).Methods: According to the timing of surgery, 75 patients with incomplete paraplegia caused by MSCC were assigned to 3 groups: within 3 days (group A), between 4 days and 7 days (group B), and after 7 days (group C). T-test, one-way ANOVA, Mann–Whitney U-test, and Chi-square test were used to evaluate the difference in the improvement of American Spinal Injury Association Impairment Scale (AIS) and ambulatory status, the incidence of perioperative complications, surgical site infection, and the length of hospital stay between 3 groups.Results: Patients with incomplete paraplegia treated in our department had an average of 17.4± 1.8 days delayed and most occurred before hospitalization (4.0± 0.4 vs 13.2± 1.8, P< 0.001). There was no significant difference in the AIS improvement between patients with different pre-op AIS. The timing of surgery was significantly correlated with AIS improvement (correlation coefficient=− 0.257, P=0.019). Sub-analysis showed that patients who underwent surgery within 7 days (group A and group B) had significantly better AIS improvement compared with group C (improved at least 1 grade, P=0.043; improved more than 1 grade, P=0.039) and the surgery timing was more important for patients with AIS B and C. The timing of surgery was significantly correlated with the length of hospital stay (correlation coefficient=0.335, P=0.003). Patients of group C had the longest length of hospital stay (P=0.002). The incidence of perioperative complications and surgical site infection did not differ significantly between the 3 groups.Conclusion: Delay surgery was common in incomplete paraplegia patients with MSCC. Patients with AIS B and C who underwent surgery within 7 days had better AIS improvement.Keywords: timing of surgery, metastatic spinal cord compression, incomplete paraplegia, neurologic function
